28 March 2023
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
This inspection was carried out by two inspectors and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
Dawson Lodge is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Dawson Lodge is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.
At the time of our inspection there was a registered manager in post.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.
During the inspection
We spoke with 10 people and 3 relatives to get their feedback about the quality of care and support people received. We spoke with 10 members of staff including the registered manager, regional directors, deputy manager, head of maintenance, team leader, administrators and care staff. We reviewed a range of records. This included support planning documentation for 7 people and multiple medicines records. We looked at 4 staff files in relation to recruitment. We also reviewed a variety of records relating to the management of the service, including risk assessments, quality assurance records, training data and policies and procedures. Following the site visits we received feedback from a further 6 staff.
28 March 2023
About the service
Dawson Lodge is a residential care home providing personal care and accommodation to up to 43 people. The service provides support to older people and people living with dementia. At the time of our inspection there were 42 people using the service.
People’s experience of using this service and what we found
Medicines management systems and processes were not always effective, and we found the provider’s medicines policy had not always been followed. The provider took action to address this shortfall during the inspection.
We found risks to people were not always managed effectively. Care plans and risk assessments did not always contain enough detail to ensure people were supported safely. The provider took action to address this during the inspection.
There were systems and processes in place to manage accidents and incidents. However, these were not always robust. The provider took action to address this during the inspection.
We received mixed feedback about the level of engagement and activities available to people. Although the registered manager and staff spoke positively about the activities available to people and the level of engagement provided to people, some of the feedback, the records we reviewed, and our observations did not reflect this. The registered manager took action to address this.
Quality assurance processes had not identified all of the concerns in the service. Records were not always complete or completed accurately or with enough detail. The registered manager took action to address this.
People and their relatives told us they felt safe and liked living at the home. Most people and their relatives felt there were enough staff. However, some people told us they had to wait at times to receive care and support. We observed safe staffing levels with staff being responsive and unhurried in their interactions with people throughout the inspection.
People's needs were assessed, regularly reviewed and included their physical, mental health and social needs. We saw evidence of people's and relative's involvement in care assessments and reviews. People were positive about the food at Dawson Lodge and confirmed they were offered choices in what they ate and drank.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. People and relatives’ views were considered by the service and were sought to make decisions about care.
The registered manager was passionate about ensuring everyone had full access to the communal spaces and creating a relaxed and homely atmosphere. People were supported to be involved in decorating the home.
Staff respected people's privacy and dignity. People told us staff were kind to them. Relatives spoke positively about how staff supported people. People were supported by staff who had the skills and knowledge to carry out their roles and responsibilities. The provider ensured staff completed specialised training courses to enable them to provide safe care and support.
The registered manager was passionate about ensuring people received responsive and empathic care at the end of their life. They completed and recorded discussions with people to help ensure their care reflected their wishes and preferences.
The registered manager and provider were responsive to our feedback and took prompt action. The registered manager was committed and passionate about their role. People, relatives and staff were able to share feedback and felt listened to.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was outstanding (published 31 October 2018).
Why we inspected
The inspection was prompted in part due to concerns received about staffing levels and people’s needs not being met. A decision was made for us to inspect and examine those risks.
We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.
The overall rating for the service has changed from outstanding to requires improvement based on the findings of this inspection.
We have found evidence that the provider needs to make improvements. Please see the Well-Led section of this full report.
You can see what action we have asked the provider to take at the end of this full report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Dawson Lodge on our website at www.cqc.org.uk.
Enforcement and Recommendations
We have identified a breach in relation to governance at this inspection.
Please see the action we have told the provider to take at the end of this report.
We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.